One Headache After Another:
Biochemistry Edition
by
Ann Taylor, Chemistry Department, Wabash College
William Clif, Biology Department, Niagara University
Part I – Blood Work
“Chris. Michelle. You go on… I’ll catch up in a minute.”
Mary hid her fear as she struggled to catch her breath. She had been so excited to go hiking with her
children. Chris and Michelle were both home on fall break, and Mary had been looking forward to the
family time. But she felt like she was hyperventilating, and now her chest was starting to hurt.
“What, we’ve fnally outlasted you on the trails?” Chris joked as he looked over his shoulder. “Mom, are you
ok? You look awful.”
“Don’t panic, but I think I need to go to the hospital.”
“Michelle! Go get the car!” Chris yelled ahead.
“Please don’t panic—I just want to get it checked out.”
“Michelle!”
After what seemed like an eternity, they arrived at the hospital. As Chris and Michelle helped their mother
into the waiting room, the ER attendant noticed them and ushered the family into a small room. Dr. Rosen
promptly took Mary’s medical history and ordered an EKG, chest x-ray, blood tests, and urinalysis.
Te tests were completed in short order, and about an hour later, Dr. Rosen appeared in the exam room. “I
have some good news, and a little bad news. Te good news is…”
“Dr. Rosen to the ER, Code Blue. Stat!” said the voice on the PA.
“Sorry, that’s my cue. But don’t worry, you’ll be fne…once we get you of of the Topamax®. Tis might take
a while, so I’m leaving your chart. I hope I’ll be back to review the test results with you, but it might be
someone else,” said the doctor as the door swung shut.
“Mom, isn’t Topamax your migraine medicine?” asked Michelle.
“Yes. It was originally designed as an epilepsy treatment, but I take it to prevent those migraines that used to
put me in bed all day. How could it be causing this?” Mary wondered out loud.
Chris broke the tension, saying, “Tese are your records, right? Let’s see what we can fgure out.” He fipped
open her chart. On the top of the pile were Mary’s blood test results:
“One Headache After Another: Biochemistry Edition” by Taylor & Clif
Page 1
Hemoglobin (g/dL)
Hematocrit (%)
Creatine kinase cardiac isozyme
Creatine kinase MM isozyme
Creatinine
pH
pCO2 (mmHg)
pCO2 (mM)
pO2 (mmHg)
HCO3- (mM)
Glucose (mg/dL)
Normal range
12.0–15.0
36–44
0–3.9%
96–100%
0.5–1.4
7.35–7.45
38–52
20–27
70–100
19–25
90–140
Mary’s results*
12.8
37.5
1
99
0.9
7.31
18.1
9.5
121.0
8.9
112
*Based upon data from J.E. Burmeister, R.R. Pereira, E.M. Hartke, and M. Kreuz. 2005. Neuro-Psiquiatr
63(2-b): 532–534.
Question
1. What appears to be Mary’s problem(s), from the results of her blood work? What sort of change has
occurred in her acid-base balance? If there is more than one problem in her blood work results, is there
a relationship among those factors?
“One Headache After Another: Biochemistry Edition” by Taylor & Clif
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Part II – Bufers
Dr. Rosen reappeared in the cubicle. “Sorry for the interruption, and for leaving you in suspense. Te good
news is that you did not have a heart attack. But I do think you’re having an unusual reaction to Topamax. It
appears to be inhibiting your renal carbonic anhydrase, leading to metabolic acidosis. We’ll be giving you an
IV, and you should taper of your Topamax under your family physician’s supervision.”
Dr. Rosen checked his pager and said, “Sorry, it’s one of those days. Again, you’ll be all right, and the nurse
will be with you shortly to start the IV.” He turned on his heel and left just as quickly as he had appeared.
“Mom, don’t worry,” said Chris. “I’m going to call one of my friends studying biochemistry. He should be
able to help us fgure this out.”
Chris dials his cell phone; yours rings. After you complete the following questions, write a one- or twoparagraph explanation to help Chris understand what’s going on with his mom.
Questions
2a. Bicarbonate is one of the main bufers in the blood. Provide a defnition of a bufer.
2b. Give an equation that allows one to calculate the pH of a bufer solution.
2c. Te pKa’s for carbonic acid and bicarbonate at 37°C are 3.83 and 10.25, respectively.
i. Write the equation for each of these equilibria.
ii. Below is a titration curve for carbonic acid. Indicate key points on the curve, such as equivalence
points and bufer regions. At what pH(s) would you expect carbonic acid species to have efective
bufering capacity? Explain.
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iii. Calculate the ratio of bicarbonate to carbonic acid at pH 7.4, using the pKa value(s) in 2c.
iv. What is unusual about these ratios? Would you expect this to be an efective bufer system at pH
7.4? Explain.
2d. Bicarbonate does bufer the blood because carbonic acid is generated from dissolving CO2 (g) in liquid water:
CO2 (g) + H2O (l)  H2CO3 (aq) pKeq° = 2.52 at 37°C
Tis reaction is catalyzed by the enzyme carbonic anhydrase. Consequently, the reaction that really
represents what’s happening when bicarbonate bufers the blood is:
CO2 (g) + H2O (l)  HCO3- (aq) + H+ (aq).
Calculate the equilibrium constant for this reaction (Hint: use Hess’s law and one of the equilibrium
expressions from question 2ci above). Would you expect this to be an adequate bufer system at
physiological pH? Explain.
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Part III – Regulation
Questions
3. Blood pH is normally regulated by the respiratory system to control the level of CO2 (g) and by the
urinary system to control the levels of HCO3- and non-volatile acids in the blood.
Metabolism
Tissue
CO2
Tubular cell
CO2
CO2 + H2O
Blood
Plasma
Alveolus
(in lungs)
Tubular lumen
Proximal renal
Capillary endothelium
CO2 + H2O
H+ +
RBC
Carbonic
anhydrase
HCO3- Cl
HCO3-+ H+
Na
+
Cl-
CO2 + H2O
Carbonic
anhydrase
H++
Na
Carbonic
anhydrase
+ HCO3-
HCO3-
Given the overall reaction, CO2 (g) + H2O (l)  H2CO3 (aq)  HCO3- (aq) + H+ (aq), what efect
would each of the following have on blood pH? Explain with LeChatlier’s principle.
a. Hyperventilating
b. Holding your breath for an extended period of time
c. Excessive ingestion of baking soda, HCO3d. Inhibiting renal carbonic anhydrase
4. Mary has an acid-base disturbance that is being compensated for with another body system. Identify the
type of disturbance and trace out the physiological pathway responsible for the compensating action.
5. For each of the treatments listed below, indicate whether you would recommend it (yes) or not (no) to
correct Mary’s problem? Explain what efect each treatment would have upon her blood pH.
a. Breathing in a paper bag
b. An IV containing pure HCO3- in an isotonic solution
c. Holding her breath for as long as she can
d. An IV containing pure CO3-2 in an isotonic solution
•
Title block illustration: ©Dawn Hudson - Fotolia.com. Case copyright held by the National Center for Case Study Teaching
in Science, University at Bufalo, State University of New York. Originally published December 28, 2009. Please see our usage
guidelines, which outline our policy concerning permissible reproduction of this work.
“One Headache After Another: Biochemistry Edition” by Taylor & Clif
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